I 

118TH CONGRESS 

2D SESSION H. R. 9067 

To amend titles XVIII and XIX of the Social Security Act to establish 

a waiver of certain training and certification requirements for specified 

skilled nursing facilities and nursing facilities. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 18, 2024 

Mr. GUTHRIE introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy 

and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend titles XVIII and XIX of the Social Security Act 

to establish a waiver of certain training and certification 

requirements for specified skilled nursing facilities and 

nursing facilities. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Building America’s 

5 Health Care Workforce Act’’. 


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1 SEC. 2. ESTABLISHING A WAIVER OF CERTAIN TRAINING 

2 AND CERTIFICATION REQUIREMENTS FOR 

3 SPECIFIED SKILLED NURSING FACILITIES 

4 AND NURSING FACILITIES. 

5 (a) MEDICARE.—Section 1819 of the Social Security 

6 Act (42 U.S.C. 1395i–3) is amended by adding at the end 

7 the following new subsection: 

8 ‘‘(l) WAIVER OF CERTAIN TRAINING AND CERTIFI9 CATION REQUIREMENTS FOR SPECIFIED SKILLED NURS10 ING FACILITIES.— 

11 ‘‘(1) ELECTION.— 

12 ‘‘(A) STATES.—A State may elect, in a 

13 form and manner specified by the Secretary, for 

14 the provisions of subsections (b) and (f) to be 

15 applied in accordance with paragraph (2) with 

16 respect to specified skilled nursing facilities (as 

17 defined in paragraph (3)) located in such State. 

18 ‘‘(B) SPECIFIED SKILLED NURSING FA19 CILITIES.—In the case of a specified skilled 

20 nursing facility located in a State that has not 

21 made the election described in subparagraph 

22 (A), such facility may make such election with 

23 respect to such facility in a form and manner 

24 specified by the Secretary. 

25 ‘‘(2) WAIVERS.—In the case of a specified 

26 skilled nursing facility located in a State that has 


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1 made the election described in paragraph (1) (or, 

2 with respect to a specified skilled nursing facility lo3 cated in a State that has not made such election, in 

4 the case of such a facility that has made such elec5 tion), the Secretary shall— 

6 ‘‘(A) apply subsection (b)(5)(A) as if the 

7 reference to ‘4 months’ in such subsection were 

8 instead a reference to ‘12 months’, except that 

9 such reference shall continue to be treated as a 

10 reference to ‘4 months’ for purposes of applying 

11 the requirement specified in clause (i)(II) of 

12 such subsection; 

13 ‘‘(B) for purposes of determining whether 

14 a nurse aide training and competency evalua15 tion program offered by or in such facility com16 plies with the requirements for such program 

17 specified pursuant to subsection (f)(2)(A)(i), 

18 allow such program to count any hours worked 

19 by a nurse aide in a skilled nursing facility or 

20 nursing facility (as defined in section 1919(a)) 

21 toward the 75 hours of initial training described 

22 in subclause (II) of such subsection; and 

23 ‘‘(C) in the case such facility is a facility 

24 described in subparagraph (B)(iii)(I) of sub25 section (f)(2), apply subparagraph (A)(iv)(I) of 


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1 such subsection as if such facility were not a fa2 cility so described, but only if the State in 

3 which the facility is located does not offer a 

4 nurse aide competency evaluation (in person or 

5 online) at least once per week or if availability 

6 is limited. 

7 ‘‘(3) SPECIFIED SKILLED NURSING FACILITY

8 DEFINED.—For purposes of this subsection, the 

9 term ‘specified skilled nursing facility’ means a 

10 skilled nursing facility that— 

11 ‘‘(A) is located in an area of a State that 

12 the State has designated as being a nurse aide 

13 shortage area; and 

14 ‘‘(B) has not received a citation for a defi15 ciency for providing a substandard quality of 

16 care relating to direct patient care during the 

17 preceding 2 years.’’. 

18 (b) MEDICAID.—Section 1919 of the Social Security 

19 Act (42 U.S.C. 1396r) is amended by adding at the end 

20 the following new subsection: 

21 ‘‘(l) WAIVER OF CERTAIN TRAINING AND CERTIFI22 CATION REQUIREMENTS FOR SPECIFIED NURSING FA23 CILITIES.— 

24 ‘‘(1) ELECTION.— 


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1 ‘‘(A) STATES.—A State may elect, in a 

2 form and manner specified by the Secretary, for 

3 the provisions of subsections (b) and (f) to be 

4 applied in accordance with paragraph (2) with 

5 respect to specified nursing facilities (as defined 

6 in paragraph (3)) located in such State. 

7 ‘‘(B) SPECIFIED NURSING FACILITIES.—In 

8 the case of a specified nursing facility located in 

9 a State that has not made the election de10 scribed in subparagraph (A), such facility may 

11 make such election with respect to such facility 

12 in a form and manner specified by the Sec13 retary. 

14 ‘‘(2) WAIVERS.—In the case of a specified nurs15 ing facility located in a State that has made the 

16 election described in paragraph (1) (or, with respect 

17 to a specified nursing facility located in a State that 

18 has not made such election, in the case of such a fa19 cility that has made such election), the Secretary 

20 shall— 

21 ‘‘(A) apply subsection (b)(5)(A) as if the 

22 reference to ‘4 months’ in such subsection were 

23 instead a reference to ‘12 months’, except that 

24 such reference shall continue to be treated as a 

25 reference to ‘4 months’ for purposes of applying 


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1 the requirement specified in clause (i)(II) of 

2 such subsection; 

3 ‘‘(B) for purposes of determining whether 

4 a nurse aide training and competency evalua5 tion program offered by or in such facility com6 plies with the requirements for such program 

7 specified pursuant to subsection (f)(2)(A)(i), 

8 allow such program to count any hours worked 

9 by a nurse aide in a nursing facility or skilled 

10 nursing facility (as defined in section 1819(a)) 

11 toward the 75 hours of initial training described 

12 in subclause (II) of such subsection; and 

13 ‘‘(C) in the case such facility is a facility 

14 described in subparagraph (B)(iii)(I) of sub15 section (f)(2), apply subparagraph (A)(iv)(I) of 

16 such subsection as if such facility were not a fa17 cility so described, but only if the State in 

18 which the facility is located does not offer a 

19 nurse aide competency evaluation (in person or 

20 online) at least once per week or if availability 

21 is limited. 

22 ‘‘(3) SPECIFIED NURSING FACILITY DE23 FINED.—For purposes of this subsection, the term 

24 ‘specified nursing facility’ means a nursing facility 

25 that— 


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1 ‘‘(A) is located in an area of a State that 

2 the State has designated as being a nurse aide 

3 shortage area; and 

4 ‘‘(B) has not received a citation for a defi5 ciency for providing a substandard quality of 

6 care relating to direct patient care during the 

7 preceding 2 years.’’. 

Æ 


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